Study Population and Clinical and Anthropometric Evaluation

The study was carried out in the context of the CUiiDARTE project (Bia et al., 2011; Santana et al., 2012a,b; Zócalo et al., 2020; Bia and Zócalo, 2021), a population-based study developed in Uruguay. In this work, we considered data from 3619 subjects included in CUiiDARTE database. This contains data on demographic and anthropometric variables, exposure to CRFs, personal and family history of cardiovascular disease and data on hemodynamic, and on structural and functional vascular parameters (Bia et al., 2011; Santana et al., 2012a,b; Zócalo et al., 2020; Bia and Zócalo, 2021; Zócalo and Bia, 2021a,b). In this work, the analysis was focused on PWA- and WSA-derived indexes.

All procedures agree with the Declaration of Helsinki (1975 and reviewed in 1983). The study protocol was reviewed and approved by the Ethics Committee of Centro Hospitalario Pereira Rossell, Universidad de la República. Prior to the evaluation, the participants provided their written informed consent to participate in the study. In subjects under 18 y, parents’ written consent and children’s assent were obtained before the evaluations. Subjects or parents (in case of subjects aged < 18 y) provided informed written consent to have data from their medical records used in research.

Before cardiovascular evaluation, a brief clinical interview together with the anthropometric and blood test results evaluation enabled to assess exposure to CRFs. Body weight and BH were measured with the participant wearing light clothing and no shoes. Standing BH was measured using a portable stadiometer and recorded to the nearest 0.1 cm. Body weight was measured with an electronic scale (841/843, Seca Inc., Hamburg, Germany; model HBF-514C, Omron Inc., Chicago, IL, United States) and recorded to the nearest 0.1 kg. Body mass index (BMI) was calculated as body weight-to-squared BH ratio. In children and adolescents, z-scores for BMI were calculated using the WHO software (Anthro-v.3.2.2; Anthro-Plus-v.1.0.4) (Castro et al., 2019).

Obesity was defined as z-score for BMI ≥ 2.0 (for subjects < 18 y) or BMI > 30 Kg/m² (for subjects ≥ 18 y). Arterial hypertension was considered to be present, if it had been previously diagnosed in agreement with reference guidelines and/or use of blood pressure-lowering drugs was reported. Cut-off values were: brachial systolic blood pressure (baSBP) ≥ 140 mmHg and/or diastolic blood pressure (baDBP) ≥ 90 mmHg (for subjects ≥ 18 y) and baSBP and baDBP > 95th percentile for sex, age, and BH (for subjects < 18 y). Personal and family histories of cardiovascular disease (i.e., presence of cerebral, coronary, aortic, or peripheral arterial disease) were assessed. A family history of cardiovascular disease was defined by the presence of first-degree (for all the subjects) and/or second-degree (for subjects ≤ 18 y) relatives with early (< 55 y in males, < 65 y in females) cardiovascular disease. History of dyslipidemia and diabetes were considered to be present if they had been previously diagnosed in agreement with reference guidelines and/or the use of lipid- or glucose-lowering drugs (respectively) was reported. Dyslipidemia was defined as total cholesterol > 240 mg/dL or high-density lipoprotein cholesterol for men < 40 mg/dL and for women < 46 mg/dL. In turn, diabetes diagnosis was based on plasma glucose levels (fasting plasma glucose ≥ 126 mg/dl). Regular (current) smokers, defined as usually smoking at least one cigarette/week, were identified.